Provider Demographics
NPI:1508443409
Name:DIANISKA, MYRON
Entity Type:Individual
Prefix:
First Name:MYRON
Middle Name:
Last Name:DIANISKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 UNION CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1324
Mailing Address - Country:US
Mailing Address - Phone:281-265-3776
Mailing Address - Fax:
Practice Address - Street 1:2503 UNION CHAPEL ST
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1324
Practice Address - Country:US
Practice Address - Phone:281-265-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2278101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health